Associating liver partition with portal vein ligation for staged hepatectomy : case report and literature review

Abstract

Introduction: In 2012, a muticentric study from Germany introduced a new two-stage hepatectomy technique to obtain extensive and rapid volumetric growth of the FLR in patients requiring right extended hepatectomies. The new technique consisted in adding a liver parenchymal partition to the portal vein ligation in the first step of a two-staged resection. The waiting interval was reduced to about 1 week. Method and materials: This case Clinic of hepatic metastases of colorectal cancer, illustrates this surgical technique. It’s the male L.S. patient, 59 years old, with a well differentiated adenocarcinoma of the right colon with synchronous hepatic metastases classified T3N1M1; remaining liver volume (left lobe after right hepatectomy) of 30%, which is incompatible with a minimum threshold of hepatic function, what alternative therapy to consider? Results: A hepatic embolization of the right portal vein was made; in the fourth week the morphological assessment of the remaining liver volume was less than the expected 40% rate, especially since it was a patient who had received chemotherapy and targeted therapy; The decision to operate the patient was made by adopting the ALPPS technique, as an intervention of choice the patient had two operating times ALPPS laboratories , the second-stage operative suites were marked by the installation of a seven-day final hepatic failure table , and a biliome occupying the lodge of the radiologically drained straight liver. Discussion: The most recent publication of the International SPILA Registry in 320 patients shows more acceptable results in terms of 90-day mortality of 9% for the overall series and 5% for hepatic metastases of colorectal cancers. In this study, patients with hepatic metastases had the best results in terms of complications and mortality, and through this clinical case we can show the feasibility of this technique in well-selected patients. Conclusion: The ALPPS is a good option for some patients with bilobar tumors with a high risk of IHP. Since SPLA is a complex surgical innovation that is currently being developed, it should only be carried out in specialized centers, in patients selected by a multidisciplinary team and listed in the international SPLA registry